Rx for electronic records

James F. Burdick

A critical opportunity to improve U.S. health care finally lies within reach. In 2004, then-President George Bush announced the goal to have a national electronic health records (EHR) system in place in 10 years. Tragically, EHR development had become bogged down, dominated by dozens of contractors profiting from a competition to sell EHR services. But at last this initiative may succeed, which will have more profound benefits for our health care than has generally been appreciated.

Information is a cornerstone of medical care. As a doctor, I believe in the healing hand of a caring bedside manner, and I believe in the commitment I made to meticulous surgical skill. But I am well aware that today, more than ever, a critical part of improving the quality of patient care requires having the facts at hand for the medical team. The long delay in getting the national health records system functioning is frustrating because the potential advantages for patient care and for cost control have been deferred.

Using an effective EHR system, doctors and other health professionals will have patients' medical histories easily available. As medical knowledge advances beyond the doctor's capacity to review it during office hours, EHR will enable physicians to have indications and contraindications for their patients' care readily at hand. Billing from EHR can decrease doctors' administrative demands. A recent analysis by the business consultants McKinsey and Company found that big data could help save up to $450 billion annually in health care costs. An effective national EHR will connect the country's accountable care organizations (multi-specialty patient care teams), hospitals and doctors, decreasing the barriers that now impede national reform.

Doctors often distrust EHR, finding it inefficient and costly. But that is because of the ill-conceived private contracting strategy. Sadly, with dozens of businesses vying for the market, doctors were stuck with expensive, time-consuming attempts to guess which proprietary system to purchase. The Centers for Medicare and Medicaid Services (CMS) attempted to encourage EHR implementation with financial incentives for doctors to show "meaningful use" of their systems. But in practice, this amounted to a financial penalty for the doctors if they had guessed wrong in choosing a system that had left them, in spite of their best efforts, with the equivalent of a car without tires or a road on which to drive it. According to a recent survey by Black Book Rankings of health care information technology, up to 17 percent of physician practices plan to ditch their current EHR system. Recently, hospitals with EHR programs from EHRMagic Inc., were stranded when this company's products were decertified. Earlier this year, Marilyn Tavenner, the newly confirmed administrator of CMS, announced a pause in EHR implementation to assess problems thus far.

Meanwhile, the monstrous commoditization of the health records effort has been expanding rapidly. The Center for Responsive Politics documented the profits from $19 billion in federal grants enjoyed by big health care information technology companies from their highly funded lobbying for advantage in the 2009 economic stimulus bill. As The New York Times reported: "With money pouring in, top EHR executives are enjoying Wall Street-style paydays." Ironically, the Affordable Care Act still leaves about 30 million Americans without health care coverage.

EHR implementation can be accomplished much more effectively. The U.S. Department of Health and Human Services might establish a basic national system to serve essential needs common to all medical interactions — including billing and data collection — and distribute it to doctors. Done free or with a reasonable user fee, it would likely be less expensive than the present multibillion-dollar profit-taking. The many institutions and practices that want extras specific to their needs could purchase them independently.

Fortunately, doctors, hospitals and reimbursement systems are evolving toward more sensible, efficient practices. The American College of Surgeons and other surgical and anesthesia associations recently called for advancing interoperability in health information exchange. Dr. Steven J. Stack, chairman of the American Medical Association's board of trustees, told officials at a federal hearing that the government needs to act quickly to improve the usability of electronic health records if the technology's touted benefits are to be realized. HHS estimates that over 50 percent of doctors are now using EHRs.

These national trends exemplify an underlying reason for hope for medical reform in general: an almost spontaneous evolution of important elements is under way. It appears that we are finally poised at the tipping point of this innovation process and can soon have an effective national EHR system.

Dr. James Burdick, a professor of surgery at Johns Hopkins University School of Medicine, had a career as a transplant surgeon and was director of the Division of Transplantation in the Department of Health and Human Services. A frequent op-ed contributor on health care issues, he is writing a book detailing his doctors' plan for health reform. His email is jburdic1@jhmi.edu.